Clinical Question

Given its significantly lower cost, can home sleep testing serve as an alternative to laboratory testing for diagnosing obstructive sleep apnea (OSA)?

Evidence-Based Answer

Home portable monitoring can be used as a substitute for in-laboratory polysomnography for the diagnosis of OSA in patients with a high pretest probability. Most patients prefer home monitoring, and clinical outcomes among patients diagnosed by either method are comparable regarding sleepiness, sleep-related quality of life, and compliance with continuous positive airway pressure (CPAP) therapy. (Strength of Recommendation: B, based on randomized controlled trials.)

Evidence Summary

A 2014 randomized crossover study evaluated home portable monitoring vs. in-laboratory polysomnography and in-laboratory portable monitoring in 75 patients with a high pretest probability of OSA.1 Patients were assigned to a home portable monitoring session or an in-laboratory polysomnography and portable monitoring session. All patients performed both sessions. The intraclass correlation coefficient (ICC) was used to evaluate consistency between multiple observers in comparing the Apnea-Hypopnea Index. A score of 0.6 or greater indicates good intraindividual agreement. The ICC for the Apnea-Hypopnea Index using polysomnography vs. home portable monitoring was 0.73 (95% confidence interval [CI], 0.61 to 0.82). There was also good intraindividual agreement between simultaneous in-laboratory portable monitoring vs. polysomnography (ICC = 0.79; 95% CI, 0.67 to 0.86) and home portable monitoring vs. in-laboratory portable monitoring (ICC = 0.75; 95% CI, 0.62 to 0.84). Using polysomnography as the diagnostic standard, the sensitivity of home portable monitoring was 90% or more for all forms of sleep apnea. Home portable monitoring was preferred by 82% of patients.

A multicenter randomized controlled trial of 373 patients with a high pretest probability for moderate or severe OSA compared laboratory-based polysomnography

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This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.